A study of psychological impact on women undergoing miscarriage at a Sri Lankan hospital setting

Abstract

INTRODUCTION: Miscarriage is common and affect one third of women some time during their lifetime. Its management has seen many advances in recent times including introduction of less interventional methods, thus seldom cause serious complications. However, the psychological morbidity associated with miscarriage is often overlooked and data on the subject among Sri Lankan population is scarce. This study was aimed at describing the presence of psychological morbidity among women after a miscarriage and to determine the factors associated with development of such morbidity in a local population. METHOD: A cohort study was carried out at a gynaecology unit of the North Colombo Teaching Hospital, Ragama, between August 2011 and April 2012. The exposed group included 198 consecutive consenting women who had an early pregnancy loss and were compared with 179 parity and gestation matched controls. Two validated psychological assessment tools, the General Health Questionnaire 30 (GHQ30) and the Edinburgh postnatal depression questionnaire (EPDS) were administered at the initial visit and 6-8 week later in both groups. The threshold levels of 6 and 9 were used for GHQ30 and EPDS scales, respectively. RESULTS: At the initial assessment, the psychological morbidity of screen positives by the GHQ30 was 42.4% and 11.7% (OR5.54, 95%CI 3.25-9.46) in the exposure and controls groups, respectively. With the EPDS it was 23.7% and 10.1% (OR2.78, 95%CI 1.55-5.0). At the 6-8 week follow up the GHQ30 screen positive rate among exposure and control groups were 25.4% vs. 9.9% (OR 3.0, 95%CI 1.64-5.48), while with the EDPS, it was 24.8% vs. 10.5% (OR 2.81, 95%CI 1.55-5.09). The factors associated with screen positive psychological morbidity among subjects of the exposure group were common to both scales. At the initial visit they included age>30 years, having had secondary or more education, a history of infertility preceding the miscarriage, a history of previous miscarriage, nulliparity and a gestation >12 weeks. The same factors, with the exception of education level, were associated with screen positive psychological morbidity with both scales at 12 weeks too. DISCUSSION: This study shows the psychological morbidity following miscarriage can be as high as 40% in the initial stage while it can persist in around a quarter of patients even after 6-8 weeks. Recognitions and providing effective treatment including psychological support should be an integral part of management of miscarriage. Risk factors associated with psychological morbidity have been identified and these should be used to identify women who are at a higher risk of developing such abnormalities in order to provide effective screening and offer treatment